Podcast # 491: Buprenorphine for Withdrawal

Educational Pearls: Buprenorphine is a semi-synthetic derivative of the opium poppy FDA approved for the treatment of opiate use disorder and chronic pain Benefit in emergency department use is the ceiling effect - producing less euphoria as well as respiratory depression with higher doses  It has an onset of 30-60 minutes, peak effect at 1-4 hours Duration of action depends is dose dependent, typically 6-12 hours, but can be as long as 24-72 hours in doses over 16 mg Use buprenorphine in those in moderate to severe opiate withdrawal Clinical Opioid Withdrawal Scale (COWS) can be used to assess and score severity of withdrawal A reasonable starting dose is 8mg. A second dose can be given after an hour, ranging from 8-24 mg depending on symptoms still present Buprenorphine can induce withdrawals so someone needs to be in true withdrawals for it to provide benefit References https://www.mdcalc.com/cows-score-opiate-withdrawal https://ed-bridge.org Herring AA, Perrone J, Nelson LS. Managing Opioid Withdrawal in the Emergency Department With Buprenorphine. Ann Emerg Med. 2019 May;73(5):481-487. doi: 10.1016/j.annemergmed.2018.11.032. Epub 2019 Jan 5. Review. PubMed PMID: 30616926. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD